Project Summary It is well established that African Americans have higher levels of cardiometabolic risk factors than whites and are less likely to achieve hypertension and diabetes control. The neighborhood environment is a critical structural determinant of these disparities given the disproportionate exposure of African Americans to deleterious residential environments. In light of this, we propose using the JHS, a state of the art epidemiologic cohort of African Americans (n=5,306), combined with rigorously assessed neighborhood contextual factors to examine longitudinal associations between features of the physical, social, and local healthcare environment and cardiometabolic risk factor development and management over a 20-year period. Understanding the role of changing neighborhood environments in shaping cardiometabolic risk factor development and management is critical to improving causal inferences and developing appropriate policies and interventions designed to mitigate the burden of cardiometabolic risk factors in this high-risk population. Furthermore, understanding these changes in the unique context of the South, a region of the country with the highest burden of chronic disease and urban areas characterized by high proportions of African Americans, low population density, and geographically dispersed amenities, will allow us to better understand how neighborhood processes operate in this setting and better tailor ongoing prevention efforts. The primary goals of the proposed study are to: 1) compile a multilevel database of time-varying neighborhood contextual data (i.e. physical, social, and healthcare characteristics) that can be linked to the Jackson Heart Study (JHS)? a unique, state-of-the art cohort study of African Americans and 2) to examine longitudinal associations of changes in neighborhood contextual factors with HTN and DBM development and management. Aim 1 will examine longitudinal associations between time-varying physical and social neighborhood features and cardiometabolic risk factors among African American adults. Aim 2 will examine longitudinal associations between time-varying neighborhood physical and social features and HTN and DBM control. Aim 3 will examine associations between local access to primary care and cardiometabolic risk factor development and management and whether features of the physical and social environment modify associations. This project will build upon detailed neighborhood data collection from Exams 1-3, incorporate emerging neighborhood data collection techniques, and take advantage of the collaborative partnership established between the Drexel University Dornsife School of Public Health and the JHS through the Center for Integrative Approaches to Health Disparities.